The Warning

During August 2005, much of Washington was chuckling over President Bush’s summer reading list recently distributed by the White House. Like his father, who during his 1991 vacation commented that he “[played] a good deal of tennis, a good deal of horseshoes, a good deal of fishing, a good deal of running—and some reading,” the younger Bush was known for vacations spent fishing and clearing brush at his Texas ranch.

But the White House reading list suggested the younger Bush was a more serious reader than his cowboy image suggested: Salt: A World History by Mark Kurlansky, Alexander II: The Last Great Tsar by Edvard Radzinsky, and The Great Influenza: The Story of the Deadliest Pandemic in History by John Barry. Hardly light summer reading, the president’s critics couldn’t imagine Bush plodding through the three books’ combined 1,500 pages. But the president’s reading list was well chosen.

As a former oilman, Bush was struck by the analogies between salt and oil. Four centuries ago, Queen Elizabeth I warned that Britain had become too dependent on foreign salt, a strategic material essential for food preservation. Since the 1974 oil embargo, American presidents have had the same concerns regarding foreign oil.

Bush also knew that President Lincoln and Russian Czar Alexander II had a warm rapport, exchanging five letters during the Civil War. Both leaders grappled with slavery. Alexander II freed twenty million Russian serfs when he issued his Edict of Emancipation in 1861. Two years later, Lincoln’s Emancipation Proclamation freed the slaves in the eleven Confederate states. Both men were later assassinated for their reforms.

But it was John Barry’s book, The Great Influenza, that most influenced Bush. The book examines how the 1918 Spanish Flu became the deadliest killer in centuries after starting as a small outbreak in Kansas. Within months the disease erupted into a worldwide pandemic that, ultimately, killed over twenty million people. The world, exhausted from the First World War and with few medical weapons to combat the virus, was unprepared.

Fourteen years before the COVID virus emerged, President George W. Bush proposed legislation to help manage a major pandemic. His warning was soon forgotten.

After reading Barry’s book, Bush was determined that the United States would be prepared when the next pandemic struck the country, as it inevitably would. The September 11 terrorist attacks had killed three thousand Americans; a pandemic could kill millions.

Two months after returning from vacation, on November 1, 2005, President Bush gave a major policy speech on how the federal government should prepare for an influenza pandemic. The president set three goals:

The first was to quickly detect outbreaks before they spread. “A pandemic is a lot like a forest fire,” Bush said. “If caught early it might be extinguished with limited damage. If allowed to smolder, undetected, it can grow to an inferno that can spread quickly beyond our ability to control it.”

The second goal was to accelerate vaccine development, especially vaccines based on cell-culture technology. “By bringing cell-culture technology from the research laboratory into the production line,” Bush said, “we should be able to produce enough vaccine for every American within six months of the start of a pandemic.”

The third goal was to establish clear emergency plans so the nation would be prepared to respond quickly and unequivocally when a pandemic threatened.

The president made another request, one that is often condemned today: Bush proposed that the federal government shield drug companies from litigation related to vaccines. In his November 1 speech, Bush asserted:

“In the past three decades, the number of vaccine manufacturers in America has plummeted, as the industry has been flooded with lawsuits. Today, there is only one manufacturer in the United States that can produce influenza vaccine. That leaves our nation vulnerable in the event of a pandemic. We must increase the number of vaccine manufacturers in our country and improve our domestic production capacity. So, Congress must pass liability protection for the makers of life-saving vaccines.”

President Bush’s proposal to shield vaccine manufactures from litigation was, and continues to be, controversial for understandable reasons. In March 2024, for example, U.S. Representative Chip Roy introduced legislation to make vaccine manufacturers liable for injuries resulting from their COVID vaccines. “Millions of Americans were forced to take a COVID-19 shot . . .” Representative Roy commented in a prepared statement. “Many have faced injury from the vaccine, but few have been afforded little recourse . . . The American people deserve justice for the infringement on their personal medical freedom and those medically harmed deserve restitution.”

Representative Roy’s proposed legislation quickly died in committee, but shouldn’t vaccine manufacturers be accountable for their mistakes? Certainly, as a Republican president, Bush was highly sensitive to the dangers of government intrusion into private markets. Yet Bush understood that few companies, accountable to their shareholders, would invest billions for the development of a vaccine that may never be needed, and if used, might bankrupt the company by lawsuits.

Shortly after the president’s speech, the Department of Health and Human Services released a 396-page pandemic study citing the importance of rapid federal and state coordination during a pandemic. The study estimated that during an influenza pandemic as many as ninety million Americans would become infected and nearly two million would die.

To fund his ambitious plan, President Bush asked Congress to appropriate $7.1 billion in emergency funding. After working its way through Congress, Bush signed the Pandemic and All-Hazards Preparedness Act (Preparedness Act) on December 19, 2006.

Bush’s support for pandemic planning was visionary, helped by memories of how unprepared America had been leading up to the 9/11 terrorist attacks. But budget pressures, politics, and apathy would slowly erode the Preparedness Act. By early 2020, Bush’s visionary plan had been reduced to the point that President Trump could complain, “We took over an empty shelf. We took over a very depleted place, in a lot of ways.”

But in 2009, the United States was ready. That year, the Preparedness Act met its first test.

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In April 2009, a new strain of influenza virus emerged in a small mountain village in Veracruz, Mexico. Five-year-old Edgar Hernandez became patient zero when he contracted a severe, flu-like illness that doctors identified as resulting from a new influenza strain. They named it Swine Flu after Edgar’s mother blamed the virus on a huge pig farm nearby.

The Swine Flu virus is a descendent of the H1N1 Spanish Flu virus which, even after a century, continues to circulate in the human population. The new virus, though, consists of an unusual combination of human, avian, and swine genetic elements, which raised concerns that much of the world’s population would have only limited natural immunity.

Five-year-old Edgar Hernandez was “patient zero'“ during the 2009 Swine Flu Pandemic.

The virus spread rapidly, and on June 11 the World Health Organization declared the Swine Flu a global pandemic. Like the Spanish Flu a century earlier, the Swine Flu largely killed children and young adults with less developed immune systems.

Remarkably, by October researchers had developed a new vaccine based on traditional egg-based cultivation in which the virus is cultivated in fertilized chicken eggs, harvested, and then inactivated to create the vaccine. The World Health Organization organized a worldwide vaccination campaign that met little resistance. Local public health authorities coordinated the distribution of masks, school and event closings, and other measures to slow the spread of the virus.

The coordinated, worldwide response to the virus worked. By late 2009 the initial wave had subsided, and on August 10, 2010, the World Health Organization declared an end to the global pandemic.

More than 150,000 people worldwide died of the Swine Flu during 2009 and 2010 including 12,500 in the United States. Little Edgar Hernandez survived, though, cheerfully attributing his recovery to ice cream.